Shock Shock is a life-threatening condition that occurs when the body is not getting enough blood flow.

This can damage multiple organs. Shock requires immediate medical treatment and can get worse very rapidly. Considerations Major classes of shock include:

Cardiogenic shock (associated with heart problems) Hypovolemic shock (caused by inadequate blood volume) Anaphylactic shock (caused by allergic reaction) Septic shock (associated with infections) Neurogenic shock (caused by damage to the nervous system)

Causes Shock can be caused by any condition that reduces blood flow, including:

Heart problems (such as heart attack or heart failure) Low blood volume (as with heavy bleeding or dehydration) Changes in blood vessels (as with infection or severe allergic reactions) Certain medications that significantly reduce heart function or blood pressure

Shock is often associated with heavy external or internal bleeding from a serious injury. Spinal injuries can also cause shock. Toxic shock syndrome is an example of a type of shock from an infection. Symptoms A person in shock has extremely low blood pressure. Depending on the specific cause and type of shock, symptoms will include one or more of the following:

Anxiety or agitation/restlessness Bluish lips and fingernails Chest pain Confusion Dizziness, lightheadedness, or faintness Pale, cool, clammy skin Low or no urine output Profuse sweating, moist skin Rapid but weak pulse Shallow breathing Unconsciousness

First Aid

Call 911 for immediate medical help. Check the person's airway, breathing, and circulation. If necessary, begin rescue breathing and CPR. Even if the person is able to breathe on his or her own, continue to check rate of breathing at least every 5 minutes until help arrives. If the person is conscious and does NOT have an injury to the head, leg, neck, or spine, place the person in the shock position. Lay the person on the back and elevate the legs about 12 inches. Do NOT elevate the head. If raising the legs will cause pain or potential harm, leave the person lying flat. Give appropriate first aid for any wounds, injuries, or illnesses. Keep the person warm and comfortable. Loosen tight clothing.

IF THE PERSON VOMITS OR DROOLS

Turn the head to one side so he or she will not choke. Do this as long as there is no suspicion of spinal injury. If a spinal injury is suspected, "log roll" him or her instead. Keep the person's head, neck, and back in line, and roll him or her as a unit.

DO NOT

Do NOT give the person anything by mouth, including anything to eat or drink. Do NOT move the person with a known or suspected spinal injury. Do NOT wait for milder shock symptoms to worsen before calling for emergency medical help.

When to Contact a Medical Professional Call 911 any time a person has symptoms of shock. Stay with the person and follow the first aid steps until medical help arrives. Prevention Learn ways to prevent heart disease, falls, injuries, dehydration, and other causes of shock. If you have a known allergy (for example, to insect bites or stings), carry an epinephrine pen. Your doctor will teach you how and when to use it. Once someone is already in shock, the sooner shock is treated, the less damage there may be to the person's vital organs (such as the kidney, liver, and brain). Early first aid and emergency medical help can save a life. References Jones AE, Kline JA. Shock. In: Marx JA, ed. Rosens Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 4. Parrillo JE. Approach to the patient with shock. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 107.

Maier RV. Approach to the patient with shock. In: Fauci AS, Harrison TR, eds. Harrison's Principles of Internal Medicine. 17th ed. New York, NY: McGraw Hill; 2008:chap 264. Update Date: 1/10/2010 Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

From: http://www.nlm.nih.gov/medlineplus/ency/article/000039.htm

Hypovolemic Shock Hypovolemic shock is an emergency condition in which severe blood and fluid loss makes the heart unable to pump enough blood to the body. This type of shock can cause many organs to stop working. Causes Losing about 1/5 or more of the normal amount of blood in your body causes hypovolemic shock. Blood loss can be due to:

Bleeding from cuts Bleeding from other injuries Internal bleeding, such as in the gastrointestinal tract

The amount of circulating blood in your body may drop when you lose too many other body fluids, which can happen with:

Burns Diarrhea Excessive perspiration Vomiting

Symptoms

Anxiety or agitation Cool, clammy skin Confusion Decreased or no urine output General weakness Pale skin color (pallor) Rapid breathing Sweating, moist skin Unconsciousness

The greater and more rapid the blood loss, the more severe the symptoms of shock. Exams and Tests An examination shows signs of shock, including:

Low blood pressure Low body temperature Rapid pulse, often weak and thready

Tests that may be done include:

Blood chemistry, including kidney function tests Complete blood count (CBC) CT scan, ultrasound, or x-ray of suspected areas Echocardiogram Endoscopy Right heart (Swan-Ganz) catheterization Urinary catheterization (tube placed into the bladder to measure urine output)

Treatment Get immediate medical help. In the meantime, follow these steps:

Keep the person comfortable and warm (to avoid hypothermia). Have the person lie flat with the feet lifted about 12 inches to increase circulation. However, if the person has a head, neck, back, or leg injury, do not change the person's position unless he or she is in immediate danger. Do not give fluids by mouth. If person is having an allergic reaction, treat the allergic reaction, if you know how. If the person must be carried, try to keep him or her flat, with the head down and feet lifted. Stabilize the head and neck before moving a person with a suspected spinal injury.

The goal of hospital treatment is to replace blood and fluids. An intravenous (IV) line will be put into the person's arm to allow blood or blood products to be given. Medicines such as dopamine, dobutamine, epinephrine, and norepinephrine may be needed to increase blood pressure and the amount of blood pumped out of the heart (cardiac output). Other methods that may be used to manage shock and monitor the response to treatment include:

Heart monitoring, including Swan-Ganz catheterization Urinary catheter to collect and monitor how much urine is produced

Outlook (Prognosis) Hypovolemic shock is always a medical emergency. However, symptoms and outcomes can vary depending on:

Amount of blood volume lost Rate of blood loss Ilness or injury causing the loss

Underlying chronic medication conditions, such as diabetes and heart, lung, and kidney disease

In general, patients with milder degrees of shock tend to do better than those with more severe shock. In cases of severe hypovolemic shock, death is possible even with immediate medical attention. The elderly are more likely to have poor outcomes from shock. Possible Complications

Kidney damage Brain damage Gangrene of arms or legs, sometimes leading to amputation Heart attack

When to Contact a Medical Professional Hypovolemic shock is a medical emergency! Call the local emergency number (such as 911) or take the person to the emergency room. Prevention Preventing shock is easier than trying to treat it once it happens. Quickly treating the cause will reduce the risk of developing severe shock. Early first aid can help control shock. Alternative Names Shock - hypovolemic References Maier RV. Approach to the patient with shock. In: Fauci AS, Harrison TR, eds. Harrison's Principles of Internal Medicine. 17th ed. New York, NY: McGraw Hill; 2008:chap 264. Spaniol JR, Knight AR, Zebley JL, Anderson D, Pierce JD. Fluid resuscitation therapy for hemorrhagic shock. J Trauma Nurs. 2007;14:152-156. Tarrant AM, Ryan MF, Hamilton PA, Bejaminov O. A pictorial review of hypovolaemic shock in adults. Br J Radiol. 2008;81:252-257. den Uil CA, Klijn E, Lagrand WK, Brugts JJ, Ince C, Spronk PE, Simoons ML. The microcirculation in health and critical disease. Prog Cardiovasc Dis. 2008;51:161-170. Update Date: 1/14/2010 Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. From: http://www.nlm.nih.gov/medlineplus/ency/article/000167.htm